Yacoubian Stephan V, Nevins Russell T, Sallis Julian G, Potter Hollis G, Lorich Dean G
Albert Einstein College of Medicine, Bronx, New York, USA.
J Orthop Trauma. 2002 Oct;16(9):632-7. doi: 10.1097/00005131-200210000-00004.
To evaluate the interobserver agreement for both treatment plan and fracture classification of tibial plateau fractures using plain radiographs, computed tomography (CT) scan, and magnetic resonance imaging (MRI).
Prospective study to assess the impact of an advanced radiographic study on the agreement of treatment plan and fracture classification of tibial plateau fractures among three orthopaedic surgeons.
SETTING/PARTICIPANTS: Patients presenting with tibial plateau fractures to a level I trauma center were evaluated with plain knee radiographs (anteroposterior, lateral, two oblique views), CT scan, and MRI. Three experienced attending orthopaedic trauma surgeons were randomly presented three sets of studies for each injury: radiographs alone, radiographs with CT, and radiographs with MRI (including soft tissue injuries documented by an experienced MRI radiologist). The surgeons were asked to render fracture classification and treatment plan based upon the blind reading of each individual radiographic set.
Agreement among the three surgeons was measured using kappa coefficients.
For fracture classification, radiographs alone yielded a mean kappa coefficient of 0.68, which increased to 0.73 for radiographs with CT scan and 0.85 for radiographs with MRI. Fracture classification (Schatzker) was changed an average of 6% with the addition of the CT scan and 21% based on radiographs with MRI. For the fracture management plan, the mean interobserver kappa coefficient for radiographs alone was 0.72, which increased to 0.77 for radiographs with CT scan and 0.86 for radiographs with MRI. MRI changed treatment plan in 23% of the cases.
Magnetic resonance imaging increases the interobserver agreement on fracture classification and operative management of tibial plateau fractures.
使用X线平片、计算机断层扫描（CT）和磁共振成像（MRI）评估胫骨平台骨折治疗方案及骨折分类的观察者间一致性。
前瞻性研究，以评估一项先进影像学检查对三位骨科医生在胫骨平台骨折治疗方案及骨折分类一致性方面的影响。
设置/参与者：在一级创伤中心就诊的胫骨平台骨折患者接受了膝关节X线平片（前后位、侧位、两个斜位片）、CT扫描和MRI检查。三位经验丰富的骨科创伤主治医生被随机给予针对每例损伤的三组检查：仅X线片、X线片加CT、X线片加MRI（包括由经验丰富的MRI放射科医生记录的软组织损伤情况）。要求医生基于对每组影像学检查的盲法阅片给出骨折分类及治疗方案。
使用kappa系数测量三位医生之间的一致性。
对于骨折分类，仅X线片的平均kappa系数为0.68，X线片加CT扫描时升至0.73，X线片加MRI时为0.85。加入CT扫描后骨折分类（Schatzker分类）平均改变6%，基于X线片加MRI时改变21%。对于骨折治疗方案，仅X线片的观察者间平均kappa系数为0.72，X线片加CT扫描时升至0.77，X线片加MRI时为0.86。MRI在23%的病例中改变了治疗方案。
磁共振成像提高了胫骨平台骨折骨折分类及手术治疗方面的观察者间一致性。
